A double whammy: The association between comorbidities and severe dengue among adult patients—A matched case-control study

Abstract

Background Dengue infection is the most prevalent mosquito-borne viral infection globally. Concurrently, there has also been an upsurge of non-communicable comorbidities. We aimed to investigate the association between these comorbidities and the development of severe dengue. Methods We performed a retrospective, case-control study involving 117 cases with severe dengue and 351 controls with non-severe dengue; matched according to gender, age (+/- 5 years old), and admission date (+/- 2 weeks). We analyzed the data using conditional odds ratio (cOR) and adjusted conditional odds ratio (AcOR) using univariate and multivariable conditional logistic regression respectively. Results Six main comorbidities namely obesity, diabetes mellitus, hypertension, hyperlipidemia, chronic pulmonary disease, and ischemic heart disease were observed among cases and controls. Multivariable conditional logistic regression model found only hypertension to be independently associated with the development of severe dengue (ACOR 2.46; 95% CI:1.09–5.53). Among symptoms at presentation, lethargy, vomiting, bleeding manifestations, and abdominal pain were associated with increased odds of severe dengue, although the associations were not statistically significant. Headache (ACOR: 0:32; 95% CI: 0.21–0.51) and skin rash (ACOR: 0.42; 95% CI: 0.22–0.81) were associated with significantly lower odds of severe dengue. Severe dengue patients were also found to have significantly higher white cell count, urea, creatinine, alanine aminotransferase, aspartate aminotransferase, creatine kinase, and lactate dehydrogenase on admission, while platelet and albumin were significantly lower compared to non-severe dengue patients. Conclusions Our study found a significant association between hypertension and the development of severe dengue in adult patients. For clinical practice, this finding suggests that dengue patients with underlying hypertension warrant closer clinical monitoring for deterioration. The association between significant derangement in various laboratory parameters and severe dengue as shown in this study is in keeping with previous reports. While further substantiation by larger prospective studies will be desirable, this association may serve to inform the dengue triaging process.

Diabetes mellitus as a risk factor for severe dengue fever and West Nile fever: A meta-analysis

“…In total, 1700 studies were retrieved from the database in the initial search, of which 278 were considered potentially eligible after reviewing the titles and abstracts. After reading the full text of the articles, 31 articles were eligible, of which 4 studies used the same dataset as the others, and 27 articles were included in this meta-analysis [15,20,[25][26][27][28][29][30][31][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52]. The processes of study screening are shown in Fig 1, and the general characteristics of the included studies and the corresponding NOS scores are shown in Tables 1 and 2.…”

Correlation of Family Support and Family Resilience With DHF Prevention Behavior in Older Adults

“…Vector control through the movement to keep the environment clean by involving all family members has proven effective in preventing dengue endemic (20). Older adults who tend to have comorbidities, such as hypertension, heart disease, and diabetes, must be monitored by their families because they are more susceptible to the dengue virus (21). In the elderly, the dengue fatality rate is higher due to comorbidities, even without considering the severity of the fever (22).…”